Curatively Resected Locally Advanced Pancreatic-Head Cancer by Down-Staging with 5-FU-Based Chemoradiotherapy and Gemcitabine: A Case Report

A 64-year-old woman with a history of diabetes and worsening weight loss was diagnosed with locally advanced pancreatic cancer based on radiological examination including computed tomography (CT) and angiography. At surgery, we found that the common hepatic artery and portal vein had been invaded by a pancreatic-head tumor. She underwent a course of chemoradiotharapy with a total of 40 Gy directed to the tumor and continuous systemic infusion of 5-FU after palliative surgery. Intravenous administration of gemcitabine was instituted after chemoradiotherapy, and the tumor dramatically shrank, relieving major vessel stenosis, Serum CA19-9 also decreased. Pancreatoduodenectomy was successful, with no residual tumor and a high probability of cure 9 months after initial surgery, and the woman has shown no sign of recurrence in 19 months. In conclusion, chemoradiotherapy with 5-FU followed by systemic administaration of gemcitabine is effective in down-staging for unresectable pancreatic cancer.